Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
Laboratory of Integrated Physiology, University of Houston, Houston, TX, USA.
J Shoulder Elbow Surg. 2014 Aug;23(8):1203-7. doi: 10.1016/j.jse.2013.11.024. Epub 2014 Feb 20.
The glenoid vault can be perforated during pegged glenoid preparation in total shoulder arthroplasty. The clinical implications of glenoid vault perforation, however, are unknown. The purpose of this study was to determine the effects of perforation of the glenoid during total shoulder arthroplasty on clinical and radiographic outcomes.
Eighteen patients with known intraoperative glenoid perforations were prospectively identified and compared with 34 patients matched by age, gender, diagnosis, and arm dominance during the same period. Patients were evaluated with multiple outcome scores. Radiographs were evaluated for glenoid lucency immediately postoperatively and at final follow-up.
Average follow-up was 28.1 months for the perforated group and 31.2 months for the matched controls. Both groups had significant improvements in outcome scores postoperatively. American Shoulder and Elbow Surgeons scores increased from 39.8 to 91.0 (P < .001) in the perforated group and from 36.9 to 82.6 (P < .001) in the control group. Constant scores increased from 24.4 to 77.4 (P < .001) in the perforated group and from 36.9 to 75.6 (P < .001) in the control group. Ninety-four percent of the perforated group and 80% of the matched controls were satisfied or very satisfied with their result (P = .896). The presence and number of perforations were not related to the American Shoulder and Elbow Surgeons score (P = .549), Constant score (P = .154), or radiographic lucency grade (P = .584).
Glenoid perforation during pegged glenoid preparation in total shoulder arthroplasty does not seem to have an adverse effect on clinical or radiographic outcomes at an average of 2 years of follow-up.
在全肩关节置换术中,钉槽预备过程中可能会穿透肩盂穹顶。然而,肩盂穹顶穿孔的临床意义尚不清楚。本研究的目的是确定全肩关节置换术中肩盂穹顶穿孔对临床和影像学结果的影响。
前瞻性识别了 18 例术中已知肩盂穿孔的患者,并与同期年龄、性别、诊断和手臂优势相匹配的 34 例患者进行比较。患者采用多项结果评分进行评估。术后即刻和最终随访时拍摄 X 线片评估肩盂透光情况。
穿孔组的平均随访时间为 28.1 个月,匹配对照组为 31.2 个月。两组术后的结果评分均有显著改善。穿孔组的美国肩肘外科协会评分从 39.8 分增加到 91.0 分(P<.001),匹配对照组从 36.9 分增加到 82.6 分(P<.001)。穿孔组的 Constant 评分从 24.4 分增加到 77.4 分(P<.001),匹配对照组从 36.9 分增加到 75.6 分(P<.001)。穿孔组 94%的患者和匹配对照组 80%的患者对结果表示满意或非常满意(P=.896)。穿孔的存在和数量与美国肩肘外科协会评分(P=.549)、Constant 评分(P=.154)或 X 线透光分级(P=.584)均无相关性。
在全肩关节置换术中,钉槽预备过程中发生肩盂穹顶穿孔,在平均 2 年的随访中似乎不会对临床或影像学结果产生不利影响。